When Antonio Maria de Lacy, M.D., oversaw the complex surgical removal of a cancerous tumor from a patient’s colon in Barcelona, Spain, in February, he was not in the room or even in the building. Using 5G technology, de Lacy supervised a team of surgeons from more than three miles away. The future of medicine is here.
The expanded reach of “telemedicine,” as this emerging field is known, offers tremendous potential for patients who otherwise might not get needed surgery. According to CNN, each year approximately 143 million surgeries worldwide are not performed due to a lack of expert surgeons; the hope is that remote surgery will broaden the availability of expert care.
Multiple technology predictions and government investment have made it clear: 5G is the future of telecommunications. Its speed is what can allow it to be used for remote surgery, but the potential of the network also creates vulnerabilities—potential hacking and other deliberate interference in machine learning, poor outcomes due to miscommunication, and mechanical failure.
5G-assisted surgery and other forms of telemedicine are already forcing changes to health care practices and Medical Liability Insurance coverage alike.
Telemedicine drives access to care, exposure to liability varies widely
Nicole Greene, Associate Vice President, Professional and Executive Liability Center of Excellence, Burns & Wilcox, Corporate Headquarters, says the first thing to consider when assessing exposure to risk is what kind of telemedicine is being used.
Telehealth can be as simple as a remote lab testing facility that sends results to a specialist at another location; while telemonitoring involves a device, such as a glucose monitor, that tracks an aspect of a patient’s physiology and sends data to a medical provider. Additionally, remote patient care uses a video or other communication technology to connect a patient and a doctor (or a doctor and another doctor, or even a doctor and a supervised robot). Each of these practices carry out potential medical liability and cyber and privacy liability.
One of the biggest impediments to more widespread implementation of telemedicine is not technological, but bureaucratic: health insurance and government bodies such as the U.S. Centers for Medicare and Medicaid Services have not yet begun reimbursing providers for remote doctor visits and consultations at the same rate as in-person encounters. Nevertheless, in regions facing severe provider shortages—including mental health care providers—the use of telemedicine is rapidly expanding to meet growing demand for care.
The big medical malpractice concern is the failure to diagnose or a misdiagnosis, and when you are utilizing data that is captured via a device … you have a limited data set.
In Arizona, where primary care providers are scarce, the state Senate passed a bill earlier this month aimed at expanding access to telehealthcare by increasing payer reimbursement for certain telemedical practices. At the end of February the Georgia Senate passed two bills, one to allow remote health care from out-of-state providers and another to establish parity in payment for remote and in-person health care services. Similar legislation is currently in the works in many other states with large rural populations.
Although a slower-than-average rate of adopting telemedicine has been observed in Canada overall, British Columbia announced on March 8 that the provincial government had earmarked $50 million for high-speed broadband to connect far-flung rural and indigenous communities to services including telehealthcare. Additionally, a study published in November of last year recommended telehealth, online support and remote clinics to reduce the observed disparity between rural and urban communities in Alberta, Manitoba and Ontario.
Facilities utilizing telemedicine in inventive ways have realized greater-than-anticipated gains. In the face of dire staffing shortages, Valley Health, a health system that serves West Virginia, Maryland and part of Virginia, implemented a tele-Intensive Care Unit. In one year, the new technology helped Valley providers save 125 lives, realize a 34 percent reduction in patients’ length of stay, lower mortality rates from sepsis, and provided Valley’s leaders with invaluable, targeted insight into areas needing improvement.
Just this month promising results were released from a large-scale study showing Apple watches can detect heart rhythm anomalies, prompting greater investment in and access to potentially life-saving, medical-grade wearable devices that can be monitored remotely by health care professionals.
These innovative technologies and their applications, according to Greene, are expanding the medical provider’s liability exposures and altering the face of Medical Liability Insurance. “When you are calling in to a remote party offering consultant advice, do you as the provider know what your insurance policy covers?” Greene asked. “Does it cover you for consulting or is it strictly for direct patient care to your specific patient?”
Greene encourages doctors and healthcare organizations to focus on specific policy language, as some policies cover remote care, and others do not.
Coverage adapts to evolving technology, care and liability
As medicine changes, so too must Medical Liability Insurance policies. Physicians and hospitals should consult a knowledgeable insurance broker to ensure their coverage keeps pace with the rapid rate of change in the medical world.
“Companies are starting to delve into what exposures exist within telemedicine and are working with their insurance brokers to tailor coverage for their needs,” said Greg Wideman, Brokerage Manager, Professional and Executive Liability Center of Excellence, Burns & Wilcox, Chicago, Illinois.
Standard medical liability insurance policies may not cover all the aspects of a particular facility, practice or provider’s exposure, Wideman explained, particularly one that is on the leading edge of researching and implementing new applications for technology.
“Doctors commonly feel their current Medical Malpractice Insurance policies provide enough coverage for them,” he said. “However, many standard markets have not accepted that telemedicine exposures are something they should be contemplating and including within their standard coverage offerings. Consequently, doctors need to look to the excess and surplus lines market to have coverage tailored to their specific needs. This could be as simple as increasing their Cyber limits or purchasing carve out policies to address their exposure.”
“The big medical malpractice concern is the failure to diagnose or a misdiagnosis,” explained Karl Olson, Vice President, Professional and Management Liability, Burns & Wilcox Brokerage, San Francisco, California. “When you are utilizing data that is captured via a device … you have a limited data set.”
“A physician somewhere else can only see so much,” Olson said. “The devices, the cameras, the sensors, even the internet connection can fail. The lack of personal interaction with a physician or a medical provider is part of the limitations inherent in telemedicine.”
Obtaining adequate Medical Malpractice, Cyber and Privacy Insurance coverage for telemedicine is quickly becoming essential, according to Wideman, particularly for technologically advanced facilities, practices and providers. While standard markets are starting to attach limited Cyber Liability Insurance coverage to their standard medical liability insurance policies, he advises providers, facilities and practices to have qualified insurance brokers detail the extent of their coverage. In some instances, the Cyber Liability Insurance coverage on standard market policies may not be enough.
Conduits of care and exposure
As medicine becomes ever more tied to technology, 5G networks become not only conduits for care but also vulnerable to hackers and other bad factors. “Medical facilities should absolutely consider (investing in) a Cyber Liability policy,” Greene said, “Especially if they are entering the telemedicine or telehealthcare space or are integrating the use of technology in how they deliver healthcare services or professional advice.”
Wideman recommends consulting experts to help determine the Medical Liability Insurance and Cyber and Privacy Insurance coverage and policy options that best meet a facility, provider or practice’s particular needs.
All medical specialties have almost certainly been shaped by technology and will continue to be shaped by advances yet to come. It is important that professionals enlist experts to ensure their Medical Liability Insurance and Cyber and Privacy Insurance policies include coverage for all of the telehealth exposures they engage in, whether revolutionary or routine.
“Telemedicine is certainly evolving in a quickly changing landscape where you have to understand the delivery of health care and technology as well as the regulatory environment,” Olson says, “and getting appropriate coverage in place is essential.”